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Diagnostic procedures & practices in drug allergy/hypersensitivity: a survey of 13 Asian countries

Asia Pacific Allergy 2020년 10권 4호 p.36 ~ 36
Tang Min-Moon, Fok Jie Shen, Thong Bernard Yu-Hor, Yun James, Li Philip Hei, 강혜련, Thien Francis, Yamaguchi Masao, Lucas Michaela, 장윤석, 김병근, Nagao Mizuho, Rengganis Iris, Tsai Yi-Giien, Chung Wen-Hung, Rerkpattanapipat Ticha, Kamchaisatian Wasu, Leung Ting Fan, 호주윤, Zhang Luo, Latiff Amir Hamzah Abdul, Fujisawa Takao, Castells Mariana C., Demoly Pascal, Wang Jiu Yao, Pawankar Ruby,
소속 상세정보
 ( Tang Min-Moon ) - Hospital Kuala Lumpur
 ( Fok Jie Shen ) - Monash University Box Hill Hospital Department of Respiratory Medicine
 ( Thong Bernard Yu-Hor ) - Tan Tock Seng Hospital Department of Rheumatology, Allergy and Immunology
 ( Yun James ) - Nepean Hospital Division of Medicine
 ( Li Philip Hei ) - University of Hong Kong Queen Mary Hospital Department of Medicine
강혜련 ( Kang Hye-Ryun ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Thien Francis ) - Monash University Eastern Health
 ( Yamaguchi Masao ) - Teikyo University School of Medicine Department of Medicine
 ( Lucas Michaela ) - University of Western Australia Medical School Pathwest and Sir Charles Gairdner Hospital Department of Immunology
장윤석 ( Chang Yoon-Seok ) - Seoul National University Bundang Hospital Department of Internal Medicine
김병근 ( Kim Byung-Keun ) - Korea University Medical Center Anam Hospital Department of Internal Medicine
 ( Nagao Mizuho ) - Mie National Hospital Allergy Center
 ( Rengganis Iris ) - University of Indonesia Faculty of Medicine Cipto Mangunkusumo Hospital Department of Internal Medicine
 ( Tsai Yi-Giien ) - Kaohsiung Medical University School of Medicine
 ( Chung Wen-Hung ) - Chang Gung Memorial Hospital Department of Dermatology
 ( Rerkpattanapipat Ticha ) - Mahidol University Ramathibodi Hospital Division of Allergy, Immunology and Rheumatology
 ( Kamchaisatian Wasu ) - Samitivej Children’s Hospital Pediatric Allergy and Immunology Division
 ( Leung Ting Fan ) - Chinese University of Hong Kong Faculty of Medicine Department of Paediatrics
호주윤 ( Ho Joo-Yoon ) - Hanyang University College of Medicine Department of Internal Medicine
 ( Zhang Luo ) - Beijing Institute of Otolaryngology Beijing Key Laboratory of Nasal Diseases
 ( Latiff Amir Hamzah Abdul ) - Pantai Hospital Kuala Lumpur Allergy and Immunology Centre
 ( Fujisawa Takao ) - Mie National Hospital Allergy Center
 ( Castells Mariana C. ) - Harvard Medical School Brigham and Women’s Hospital Department of Medicine
 ( Demoly Pascal ) - University Hospital of Montpellier Department of Pulmonology
 ( Wang Jiu Yao ) - National Cheng Kung University Hospital Department of Pediatrics
 ( Pawankar Ruby ) - Nippon Medical School Department of Pediatrics

Abstract


Background: The issues and challenges in the diagnosis of drug allergy/hypersensitivity among children and adults in Asia are likely to be different from non-Asian countries.

Objective: To study the diagnostic modalities used in the evaluation and management of drug allergy/drug hypersensitivity reactions (DHRs) among member societies of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI).

Methods: A questionnaire comprising 41 questions was circulated electronically to member societies and individual members of APAAACI between January 23, 2020 and March 6, 2020.

Results: Twenty-six respondents from 15 member societies and 1 individual member responded. European DHR guidelines were most commonly used. Skin prick and intradermal testing was used by 100%, with only 60% having access to commercial penicillin skin test reagents. In vitro-speci?c IgE tests were used by 75%, and basophil activation test by 56.3% for immediate DHR. Patch tests were used by 75% in contrast to lymphocyte transformation tests by 25% for nonimmediate DHR. Drug provocation tests were used by 68.8%, the most common indication being to exclude hypersensitivity where history/symptoms were not suggestive of drug hypersensitivity/allergy (93.3%). Human leukocyte antigen (HLA) genotype testing was mandatory among 25% respondents before new carbamazepine prescriptions, and 8.3% for allopurinol prescriptions.

Conclusions: There was increased use of skin testing for iodinated contrast media hypersensitivity and patch testing for nonimmediate DHR. HLA genotype testing prior to new carbamazepine, allopurinol and abacavir prescriptions remain variable despite strong associations for severe cutaneous adverse reactions with Asian ethnicity. Results of this survey form a useful framework for developing educational and training needs and for improving access to drug allergy diagnostic and treatment modalities across APAAACI member societies.

키워드

Anaphylaxis; Contrast media; Penicillins; Pharmacogenetics, Skin tests

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